| NPI | 1659346674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN MD0000040243) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: TN 40243) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2022-10-18 |